Medical Specialties: Rheumatology

by Kristi Gadalla

Pre-health students interested in arthritis and other connective tissue disorders might consider rheumatology as an internal medicine specialty in musculoskeletal disease. Rheumatologists treat a variety of conditions involving pain and inflammation in bones, joints, muscles, and the tissues that connect them.

“It’s a great specialty if you’re interested in high technology and the cutting edge of medicine,” said Dr. Daniel Arkfeld, MD, on the benefits of pursuing rheumatology. “The field is always evolving and it’s very conducive to developing close relationships with patients.”

Dr. Stratos Christianakis, MD, also saw rheumatology as a great way to connect with patients on a more personal level. “Before medical school I wanted to pursue orthopedic surgery,” he said, “But then I realized that I enjoyed my rounds spent in the clinic more than the ones spent in the OR. Whereas surgery is more isolated and detached, pursuing rheumatology allowed me to develop long-term relationships with patients, which made treating them and improving the quality of their lives all the more rewarding.”

On the topic of deciding to change specialties, Christianakis said, “Sometimes I actually think we [rheumatologists] are going to put the ortho guys [orthopedic surgeons] out of business. Technological advances are allowing us to find much safer and less invasive treatment options for rheumatic diseases…I recently worked on a team with surgeons who proposed surgical implants to reduce the inflammation in the hands of an OA [osteoarthritis] patient…we were able to use a medication instead that was just as effective.”

Osteoarthritis is the most common disease that falls under the jurisdiction of rheumatology, as it affects approximately twenty-seven million Americans. Also known as wear and tear arthritis, osteoarthritis is generally the result of aging and is characterized by the breakdown of cartilage. This causes bones to rub together, which results in pain, swelling, and stiffness.

Regarding the challenges posed by treating osteoarthritis, Arkfeld said, “There is still so much we don’t know about OA. While some symptoms can be treated with medication, most are still assessed with invasive surgeries and not completely alleviated.” As a result of the uncertainty surrounding it, current research regarding the treatment of osteoarthritis is extensive and includes the investigation of medications to effectively reduce inflammation, surgeries to replace the cartilage that has worn down, and genome analysis to more accurately predict the cause of osteoarthritis.

Another prevalent disorder treated by rheumatologists is rheumatoid arthritis, as it affects about 1.3 million Americans, three quarters of which are women. The frequent intersections of rheumatology and immunology are evident in the treatment of RA, as the disease is caused by failure of the immune system to facilitate a conducive environment for joints, cartilage, and connective tissue. In fact, RA is actually characterized by irregular immune reactions that resemble an attack on connective tissue essential to joint health, thereby classifying the condition as an autoimmune disease.

When asked whether treating OA or RA posed more of a challenge, Christianakis said, “The progress of the last fifteen years in the treatment of RA is remarkable…the new medications have made all the difference, and highly advertised ones like Humira really spread awareness of the disease. A combination of these factors has given us an ultimately more cohesive understanding of RA.”

Research on treatment options for RA is being conducted by physicians like Dr. Karina Torralba, MD, who said, “technology is a gift when it comes to solving the puzzle that is RA treatment. Equipment like ultrasound has been hugely essential to the progress that we’ve made and hopefully will continue to make.” Torralba just wrapped up a research project using ultrasound to analyze RA autoimmune responses. “I really loved working with ultrasound,” she said, “It’s a relatively new technology in our field and it’s already contributed so much to our understanding of the disease.”


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